Medical Records Technician Iii

About the Position

This position will be 100% on campus Monday - Friday hours are 8:00am - 5:00pm. This position has primary responsibility for HIPAA risk assessment, investigation and data tracking related to HIPAA. Abstracts data from charts to be reported to the Joint Commission, CMS, and ORYX. This position provides back-up to the MRT III for utilization review. This position supports and provides back-up for all other duties listed below as needed.

• This position will request and obtain all authorizations for third party payer insurance reimbursement, based upon medical necessity.
• Third party payers will include, but are not limited to Medicare, Medicaid, Tri-Care, and private insurance carriers.
• Will request authorizations each day by referring to the daily admissions list, and the third party payer form, and initiates the authorization process.
• Understands which patients are eligible for third party payer reimbursement, and all processes related to obtaining authorizations.
• Maintains a current contact list for each insurance carrier, and all departments/persons involved in utilization review.
• Submits appropriate medical record documentation to third party payers upon request and at established intervals.
• Performs appropriate follow-up for lack of response from the third party payers or others involved in the utilization review process.
• Independently problem-solves issues in the authorization request process, but understands when additional review is required.
• Maintains a tracking tool for authorization requests to minimize incidence of missing information or delay in submission of required documentation, or renewal of authorizations.
• Reports current authorization information or concerns to the Utilization Review Manager, weekly, at a minimum.
• Schedules clinical consultation meetings for provider/clinical team member with the insurance representative as needed.

• This position both performs the following tasks and oversees the work of staff reporting to this position who have the primary responsibility for these duties.
• This position must have an in-depth understanding of the processes and regulations for all aspects of this duty.
• ROI/HIPAA /Patient information
• Independently releases patient information to requesters per required HIPAA Federal Regulations.
• Maintains release of information log, and documents all information released into Release of Information database.
• Conducts interviews and determines the sanctions related to HIPAA violations.
• Work with CDHS HIPAA Privacy and Security Officer to assist in modifying policies and procedures to incorporate OCR & CDHS HIPAA regulations.
• Work with HIPAA Officer and management to mitigate Security and Privacy breaches and/or incidents.
• Identify staff that has not completed mandatory CDHS HIPAA training related to violations and risk assessments.
• Report all HIPAA violations and breaches to HIPAA Officer and Division Management.

• Completes audits using Google sheets audit form for; ECT, admissions, concurrent, outpatient, discharges, and deaths for compliance with all hospital policies, procedures and regulatory agency requirements.
• Responsible for running the “Saved not Signed” and “Therapeutic Documentation” reports and notifying staff of documents needing to be signed.
• Responsible for tracking various assessments and notes in the BEHR in accordance with CMS requirements.
• Keep a record of due dates for RN and Social Work annual assessments, and send reminders to staff.
• Requests death certificates for patients who are deceased.
• Flags deficiencies in BEHR for providers.
  • Communicates deficiencies as appropriate.

• Abstract data from charts to be reported to the Joint Commission, CMS, and ORYX.
• Assures the accuracy of core measures for admission from the BH intake in BEHR.
• Scan Suicide Precautions Level I (SPI), signature pages, and group tracker.
• Maintains the Standard Operating Procedure (SOP) for abstracting and scanning.

• Must be familiar with BEHR, the electronic Health record, specifically Power Chart;
  Access HIM, and Revenue…